孕妇人巨细胞病毒感染三种检测方法的临床应用价值分析

Evaluation on Clinical Application of Three Testing Methods for Human Cytomegalovirus Infection in Pregnancy

目的 探讨酶联免疫吸附试验 (EL ISA )、套式 PCR(N - PCR)及逆转录 PCR(RT- PCR)三种方法在孕妇人巨细胞病毒 (HCMV )感染中的临床应用价值。 方法 采用 EL ISA法筛查孕妇5 5 81例 ,对其中 10 0例单纯性 Ig M阳性 (第一组 )、6 9例 Ig M阳性合并血清 DNA阳性 (第二组 )、6 5例 Ig M阳性合并 m RNA阳性 (第三组 )进行研究 ,监测其感染状况、母婴传播及异常妊娠结局。 结果 血清 DNA阳性、m RNA阳性与 Ig M阳性的符合率分别为 5 6 .2 5 %、4 3.75 % ;三组母婴垂直传播率分别为 19.0 0 %、4 0 .5 8%、4 6 .15 % ;第二、三组与第一组比较差异均有极显著性 (P<0 .0 1) ;二、三组之间差异无显著性 (P>0 .0 5 ) ;三组流产、死胎、畸形、新生儿死亡等异常妊娠结局的发生率分别为 10 .0 0 %、15 .94 %、30 .77% ;第三组异常妊娠结局的发生率 4倍于第一组 (OR=4 .0 0 ,P<0 .0 0 1) ,第二组异常妊娠结局的发生率 2倍于第一组 (OR=2 .343,P<0 .0 5 ) ;第三组与第二组之间异常妊娠结局的发生率差异无显著性 (P>0 .0 5 )。 结论 Ig M阳性只能作为孕妇 HCMV感染的筛查指标 ;Ig M阳性合并血清 DNA阳性或 m RNA阳性为活动性感染指标 ;Ig M阳性合并血清 DNA阳性或m RAN阳性具有较高的母婴垂直传播率及异常妊娠结?

Objective To evaluate the testing value of ELISA, N-PCR and RT-PCR in clinical practice for pregnant women with HCMV infection. Methods 5581 pregnant women were screened by ELISA. 100 cases with positive IgM (group 1), 69 positive IgM combined with positive serous DNA (group 2) and 69 with positive mRNA (group 3) were studied on maternal-fetal transmission and pregnancy outcome. Results The accordance rate of group 3 and group 2 with group 1 are 56.25% and 43.75%, respectively. The maternal-fetal transmission rate in three groups is 19.00%,40.58% and 46.15%, respectively. A significant difference existed between group 2, 3 and group 1(P<0.01) but there was no significant difference between group 2 and group 3(P>0.05). The total rate of spontaneous abortion, fetal death, fetal abnormality and neonatal death are 10.00%,15.94% and 30.77% in different groups, respectively and that of group 3, 2 are 4 and 2 times as much as that of group 1, respectively (OR=4.00, P<0.001, OR=2.343, P<0.05). However, there is no significant difference between group 3 andgroup 2. Conclusions HCMV- IgM(+) can only be considered as ascreening norm for pregnant women with HCMV infection, while complicated with serum DNA(+) or mRNA(+) indicates active infection and has a high incidence of maternal-fetal transmission and abnormal pregnancy outcome.